Healthcare Provider Details

I. General information

NPI: 1558680991
Provider Name (Legal Business Name): DENNIS MONTOYA P.T., DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 S CONGRESS AVE
LAKE WORTH FL
33461-4746
US

IV. Provider business mailing address

4801 S CONGRESS AVE
LAKE WORTH FL
33461-4746
US

V. Phone/Fax

Practice location:
  • Phone: 561-967-6500
  • Fax: 561-472-0467
Mailing address:
  • Phone: 561-967-6500
  • Fax: 561-472-0467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT25435
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: